Jacky's debate group

Let us not forget the “Is-Ought” problem pointed out by philosopher David Hume. That is, we cannot derive an “is” from an “ought”. We cannot simply say that U/S “is” effective or “is not” effective based on what we feel “ought” to be a good or bad outcome. To claim that "improved healing" or "return to function" is a positive outcome is only to suggest that people “ought” to be healthy and “ought” to return to function. This claim is purely based on your own opinions. Who’s to say that it is wrong for a patient to wish to be “not healthy” or wish to “never return to full function”? To push your personal ideals on others is wrong. We must therefore conceit that this conversation is completely pointless and has no answer.

This is an excellent question! If we were talking about a medication and not ultrasound then animal studies would certainly not cut it. So why is it that we are ok with proceeding just on scientific theory or animal studies? I would be interested in getting peoples thoughts on this.

Unfortunately many of the studies on ultrasound have a fair share of flaws. This of course means that many of systematic reviews are just compilations of mostly lower quality studies. Good quality RCTs are definitely needed.

This is an excellent point. If U/S was proven to be completely ineffective then we would be faced with a difficult ethical decision as to whether we should be using U/S with the only effect being a placebo effect. This however is not the case - we have some plausible therapeutic effects on top of the plausible placebo effect. Seems like a good use of time.

Post on behalf of Alice Chan:

Even the evidence is not clear for a lot of modalities, all modalities should have a place in physical therapy as long as they do no harm. Research shows that simple interactions with a healthcare worker have placebo effect on patients. Modalities could also have similar placebo effects. This positive psychological experience alone can be a "therapeutic" benefit.

Plus, many patients do not like exercises or do not follow their exercise prescriptions; modalities can serve as an incentive to keep a patient seeing a physiotherapist and to exercise inside the clinic.

Sure there is evidence but as pointed out by Kiera, much of this is from animal studies. We need supporting clinical trials on humans to support our actions.

Hello,

I would like to clarify that ultrasound does not actually serve as an anti-inflammatory agent. This is something that has confused me in the past as well. It turns out that ultrasound is actually pro-inflammatory. This is not to say it is not useful in the inflammatory phase as it may help in optimizing the inflammatory phase of healing.

I support the use of ultrasound. I use it on a regular basis as an anti-inflammatory agent and have found it to be very effective.

There is no supporting evidence for the use of ultrasound. To use ultrasound is to ignore the principles of evidence based practice.

EBP is more than just literature. We must not lose sight of the other components of EBP, namely the patient and the clinician.